Citation Nr: 1551188 Decision Date: 12/07/15 Archive Date: 12/16/15 DOCKET NO. 06-37 094A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to an initial rating in excess of 30 percent for furunculosis and folliculitis of the pelvic area and upper posterior thighs. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. Barstow, Counsel INTRODUCTION The Veteran had active military service from September 1965 to June 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2006 rating decision of the VA Regional Office (RO) in Philadelphia, Pennsylvania. Due to the location of the Veteran's residence, jurisdiction of this appeal is with the RO in Columbia, South Carolina. A Board decision in February 2012 denied an initial rating in excess of 30 percent for the Veteran's service-connected skin disability. The Veteran thereafter appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court) as to this issue. In an Order dated in October 2012, the Court granted a Joint Motion for Partial Remand (JMPR) by the Veteran and VA General Counsel, which was incorporated by reference, to vacate the Board's decision as to this issue and remand the case for readjudication in accordance with the JMPR. The Board also remanded the issue of entitlement to a total rating based on individual employability due to service-connected disability (TDIU). Review of the record indicates that the RO is still completing the requested development and that this issue has not been recertified back to the Board for disposition. Consequently, this issue will be addressed in a later decision. In February 2013, the Board obtained an opinion from the Veterans Health Administration (VHA) regarding the use of a particular medication to treat the Veteran's disability. As the opinion was not considered adequate, the Board remanded the case in April 2013 to obtain an additional medical opinion. Following the April 2013 requested development, a Board decision in December 2013 again denied the Veteran's claim for an initial rating in excess of 30 percent for the service-connected skin disability. The Veteran thereafter appealed this decision to the Court as to this issue. In May 2015, the Court issued a Memorandum Decision vacating the Board's decision as to this issue and remanding the case for readjudication. The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ). VA will notify the Veteran if further action is required. REMAND Regrettably, another remand is necessary. As noted in the May 2015 Memorandum Decision, the Board did not discuss whether the Veteran's doxycycline treatment is similar to a corticosteroid or other immunosuppressive drug in the context of treating his disability. The Board also did not discuss whether the Veteran's disability would affect more than 40 percent of his entire body or exposed skin were he not treated with doxycycline. As the Board is unable to use its own medical judgment, a remand to afford the Veteran a VA examination with an adequate opinion addressing whether the use of doxycycline treatment is similar to a corticosteroid or other immunosuppressive drug and what percentage of the Veteran's entire body or exposed skin would be affected if not for the use of doxycycline is necessary. Accordingly, the case is REMANDED for the following action: 1. Procure records of post-service treatment that the Veteran has received. The Board is particularly interested in records of treatment received from the Columbia VA Medical Center. If any such records identified by the Veteran are not available, he should be so informed, and notations as to the unavailability of such records and as to the attempts made to obtain the documents should be made in the claims file. All such available reports should be associated with the claims folder. 2. Accord the Veteran an appropriate VA examination to determine the current level of severity of his service-connected skin disability. His claims file, including a copy of this remand, must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies should be incorporated into the examination report to be associated with the claims file. The examiner should opine as to the following: i) Whether doxycycline treatment is considered to be of the same or similar level of treatment as corticosteroids or other immunosuppressive drugs in the context of treating the Veteran's furunculosis and folliculitis. ii) What percentage of the Veteran's entire body and exposed areas are affected by his furunculosis and folliculitis. iii) Without doxycycline treatment, estimate what percentage of the Veteran's entire body and exposed areas would be affected by his furunculosis and folliculitis. A complete rationale should be given for all opinions and conclusions expressed. If the examiner must resort to speculation to render the requested opinions, he/she must state what reasons, with specificity, that this question is outside the scope of a medical professional conversant in VA practices. 3. Ensure that the examination report complies with (answer the questions posed in) this Remand. If any report is insufficient, it should be returned to the examiner for corrective action, as appropriate. 4. Then, readjudicate the issue remaining on appeal. If any benefit remains denied, the Veteran and his representative should be provided a supplemental statement of the case and given an appropriate opportunity to respond. The case should then be returned to the Board for further consideration. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West 2014). _________________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2014), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2015).